Memory Lane Brick Order Form

First Name:

Last Name:

Phone Number:--

Email Address:@

Address:

City:

Zip Code:

State:

Your Brick can be imprinted with three lines of up to 14 characters each.
NOTE: A space counts as a character.
In the squares below,print clearly (using CAPITAL LETTERS) the name or message you would like.
Your text will automatically be centered on the brick.

Brick Inscription (14 Characters per line including spaces)

Click to Print This Page

Cost per brick is $75.
Please make a check or money order payable to Oceanside Education Foundation.

Please mail completed form and payment to:

Memory Lane Bricks
Oceanside Education Foundation
c/o Oceanside Union Free School District
145 Merle Avenue
Oceanside, NY 11572